RLG SPORTS
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RLG
SPORTS
Sign Up Now
Menu
Home
About Us
Activities
Pricing
FAQ
Contact Us
Registration
RLG Sports Registration/Liability Form
Please complete and submit the form to enroll your child(ren).
Registration/Liability Form
Parent/Guardian’s Name
*
Parent/Guardian’s Email
*
Parent/Guardian’s Phone Number
*
Parent/Guardian’s Address
*
Parent/Guardian’s Address
Street Address
Street Address
Apt. #
Apt. #
City
City
State/Province
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State/Province
Zip/Postal
Zip/Postal
Emergency Contact’s Name
*
Emergency Contact’s Phone Number
*
Doctor/Physician's Name
Preferred Hospital Name
Hospital Phone Number
Child 1 Information
Please enter your child's information.
Child 1 Name
*
Child 1 Age
*
Child 1 Grade
*
Pre K - 12
Child 1 Medical Needs/Concerns
Child 2 Information
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Child 2 Name
Child 2 Age
Child 2 Grade
Pre K - 12
Child 2 Medical Needs/Concerns
Child 3 Information
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Child 3 Name
Child 3 Age
Child 3 Grade
Pre K - 12
Child 3 Medical Needs/Concerns
Child 4 Information
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Child 4 Name
Child 4 Age
Child 4 Grade
Pre K - 12
Child 4 Medical Needs/Concerns
Child 5 Information
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Child 5 Name
Child 5 Age
Child 5 Grade
Pre K - 12
Child 5 Medical Needs/Concerns
Child 6 Information
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Child 6 Name
Child 6 Age
Child 6 Grade
Pre K - 12
Child 6 Medical Needs/Concerns
The participant(s) understands and agrees that during their time of participating in this program, R.L.G. SPORTS/MINISTRIES shall not be liable for any damages arising from personal injuries sustained in, or injuries/illness incurred on, or about the premises of the program designated area. The parent/guardian assumes full responsibility for any injuries or damage which may occur, and does hereby fully and forever release any discharge R.L.G. SPORTS, and employees, from any action or cause of action present or future whether be known or unknown, anticipated, resulting from or arising out of this program.
I agree to the above liability clause. Please sign below.
Parent/Guardian Signature
*
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